This Summary Plan Description/Premium Conversion Plan Group Plan Application is a binding agreement between AlphaHR, LLC and you and, if applicable, the company or other legal entity you represent (collectively, "you"). By signing this Summary Plan Description/Premium Conversion Plan Group Plan Application below, you accept the terms of the Plan Documentation Agreement, you acknowledge receipt of the attached HIPAA Business Associate Agreement signed by AlphaHR, LLC that assures compliance for your records.
I have read, understand, and agree to the terms and conditions stated in this Summary Plan Description/Premium Conversion Plan Group Plan Application, the Plan Documentation Agreement, and the Business Associate Agreement (if applicable), as attested by the signature below, effective on the date of the signature.